Practical notes on diagnosis, prognosis, and treatment in cases of delirium tremens / by Thomas Laycock.

  • Laycock, Thomas, 1812-1876.
Date:
1862
Catalogue details

Licence: Public Domain Mark

Credit: Practical notes on diagnosis, prognosis, and treatment in cases of delirium tremens / by Thomas Laycock. Source: Wellcome Collection.

Provider: This material has been provided by The University of Glasgow Library. The original may be consulted at The University of Glasgow Library.

    14/32 (page 12)
    to produce a temporary calm, and opium 6r its salts have been recommended on all sides as the sheet-anchor of the practitioner, —as the things which will surely calm all this wild and distressing disturbance, and allay the fears . and apprehensions, not of the patient only, but of Ills friends and the bystanders. Tliese drugs are easily accessible and readily taken, and if not successful, the strait- waistcoat is available. On tlic other hand, the rational method demands that not only the practitioner, but the relatives and bystanders, shall look upon this strange and distressing turmoil with the calmness which rejects all mechanical means of coercion • shall prescribe for, nurse, and watch the sufferer as if he were in nothing worse than a troubled waking dream ; and shall await with firm confidence the result of treatment which deliberately promises no immediate results. How far all concerned are defective in these requisites I need not say; but the causes of the defect are obvious. Firstly, the practitioner and friends believe the disease is of a very serious if not fatal import, and ought not, therefore, to be left to simple and apparently insuflicient means. Secondly, the knowledge of the forms which are serious, and end either in death or in insanity, is not clearly set forth in books; or, in other words, prog- nosis is imperfect, and this because the natural course of the aff'ection, in its various forms, is not known. Thirdly, the pathol- ogy of the disease participates in the obscurity and defects which attaches to all the class of mental disorders to which delirium tremens essentially belongs. Hence, wliile the diagnosis is imperfect, and the etiology obscure, the pathological anatomy is worse than de- fective—is, I humbly think, altogether erroneous. What then would be of the greatest value at the bedside ? Two things chiefly,—a sound diagnosis and prognosis. These would enable us to decide, 1. What cases will run a natural course and terminate in health, and what are likely to end in death or chronic cerebral disease; 2. What means are available in each case to the quieting of the patient and his safe nursing and watching until health returns, and what for preventing the disorder terminating in chronic disease and death. These practical points I will now inquire into. But, in the first instance, let us endeavour to get as clear an idea as is possible of the morbid conditions or disorders designated delirium tremens, as a necessary preliminary to inquiry. It is to be observed, in limine, that both in nosology and in practice, the term delirium tremens ap]ilies to a group of disorders whereas, strictly and literally taken, it designates but one of the group. By it we thus understand an acute cerebral afiection caused by intoxicating drinks, of which delirium and tremors are the prominent symptoms. Other acute cerebral affections are accompanied or manifested by delirium and tremors, but then they are differentiated from delirium tremens by the causation. Strictly, however, we ought not to include other acute cerebral affections caused by the habitual use of intoxicating drinks, w^hich are not